ADVANCED systemic therapies such as biologic drugs and Janus kinase inhibitors have transformed the management of atopic dermatitis (AD). While the National Institute for Health and Care Excellence (NICE) provides guidance on their use, there appear to be national differences in how patients access these therapies. A recent study examined whether the type of centre, district general hospitals or specialist centres, impacts prescribing practices, use of traditional immunosuppressants, and the timing of initiation of advanced systemic therapies for patients with AD in the UK.
This retrospective, multi-site study reviewed the clinical records of 350 patients across seven centres: four district general hospitals where patients with AD are seen in general dermatology clinics, and three specialist centres with dedicated AD services. Data collected included demographics, immunosuppressant use, choice of advanced systemic therapy, and the timeline for switching. A psoriasis cohort was included for comparison to evaluate potential differences in treatment transition.
The study population had a mean age of 43.9 years, with 56.2% male and 44.6% White patients, and no significant demographic differences between hospital types. Methotrexate, ciclosporin and phototherapy were the most common immunosuppressants used, in that order. Patients with AD spent considerably less time on immunosuppressants than those with psoriasis (2.54 years versus 5.02 years), highlighting differences in treatment approaches between conditions. Side effects varied significantly by drug type.
A key finding was that patients treated at specialist centres experienced a significantly shorter delay in switching from immunosuppressants to advanced systemic therapies, 1.9 months compared to 3.7 months in district general hospitals. The most common cause of delay was homecare, a service that delivers medicines directly to patients, which proved more problematic in district general hospitals.
These findings suggest that access to advanced systemic therapies in AD is quicker and more coordinated in specialist centres, where streamlined care pathways and dedicated resources contribute to improved treatment timelines and potentially greater patient satisfaction.
Reference
Pathmarajah P et al. Comparative real-world analysis of national variations in advanced systemic therapy initiation in atopic dermatitis across the UK. Abstract 2062. EADV Congress 2025, 17-20 September, 2025.
